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Comprehensive QI Toolkit

How to Implement a MOC Part 4 QI Project on Developmental Surveillance, Screening, and Referral
    Background and Project Overview

    The Don't Just Wait and See: Improving Developmental Screening and Follow-up quality improvement project aimed to improve and promote monitoring, screening, and follow-up for developmental concerns in primary care pediatric practice. Between November 2015 and January 2016, 28 project participants collaborated to test, implement, disseminate, and plan to sustain strategies identified to improve and promote developmental surveillance, screening, discussion of screening results and referral for concerning screening results.

    A comprehensive quality improvement toolkit is available to assist practices and other organizations interested in implementing a similar quality improvement / Maintenance of Certification project in their state. All resources are free and available for customization.

    For more information about this project and the resources included below, watch this recorded webinar.

    Maintenance of Certification (MOC) + Quality Improvement (QI) Project Toolkit

    Below is a comprehensive toolkit containing information and resources that can be used when implementing a QI project.

    a.       Project Planning
    In this section are resources to assist you in planning a practice quality improvement (QI) project.  Sample Institutional Review Board (IRB) and Maintenance of Certification (MOC) Part 4 applications and supporting documentation are included.

    b.      Pre-work, Orientation and Baseline Data Collection
    Resources in this section will help with participant orientation, including the goal and purpose of the QI project, project expectations, requirements, and pre-work.

    Practices and other organizations are eligible to apply for MOC Part 4 projects through the Academy’s MOC Portfolio Sponsorship program. As an approved Portfolio Sponsor by the American Board of Pediatrics (ABP), the AAP can evaluate and approve projects for MOC credit. For more information on how to participate or submit a project for approval through the AAP, visit ​the Academy's MOC Portfolio Program page.

    c.       Learning Session
    An in-person learning session is an opportunity for participants to meet project staff and other participants face-to-face, review pre-work, and project data, learn about the project topic area, and make plans for testing changes within practice. Below are materials for this type of a meeting, including a sample agenda, PowerPoint presentations, and an evaluation.

    d.      Action Period
    The "action period" is when participants implement small tests of change using project interventions, such as those provided in the change package and during the learning session. The action period can include the following activities: monthly data collection via record reviews, completion of brief narrative progress reports, monthly educational webinars, and testing changes using Plan, Do, Study, Act (PDSA) cycles. 

    Below are resources designed to assist in implementation of all aspects of the action period, including sample webinar presentations, reminder emails, and a change package with resources related to developmental surveillance and screening.

    Resources in this section are designed to help project organizers evaluate successes and challenges outside of the medical record review data, as well as highlight reported prac​tice changes. Sample resources include post-implementation surveys, qualitative interview questions, and MOC Attestation processes. 


    Project participants were asked to submit 30 to 40 patient record reviews for baseline. For the following three months, participants were asked to submit 15 to ​20 patient record reviews using a web-based data aggregation tool, for a total of 4 cycles of data collection.

    The target population for this project were patients seen for their 9-, 18-, and 24- or 30-month health supervision visits.

    Measures for this project focused on the following:​

    • Screening for developmental concerns at 9-, 18-, 24-or 30- months and autism at 18- and 24-months.
    • Communicating screening results with families and documenting the discussion in medical records, and
    • Making a referral for follow-up care within 7 calendar days of receiving a positive screening result 

    ​Aggregate Data Results
    Aggregate record review data showed improvement in most measures, including the following: 

    • ​Performance on the developmental screening measure started at 88% and remained fairly steady throughout the project. Performance on the Autism screening measure was 83% at baseline and increased to over 90% by cycle 4.
    • Documentation of discussion of developmental screening results (both positive and negative screening results) with families increased from 78% at baseline to over 90% and the documentation of discussion of autism screening results (both positive and negative screening results) increased from 72% at baseline to more than 90% by cycle 4.​

    • Referral rates for concerning developmental screening results increased from 57% at baseline to over 90% by cycle 4. Referral rates for concerning Autism screening results increased from 26% at baseline to over 90% by cycle 4.​​

    Additional project highlights include the following:

    • 70% of participants used resources and/or tools provided by the project, such as the CDC Learn the Signs. Act Early. Milestone Checklists and the AAP Developmental Screening Coding Fact Sheet.
    • Approximately 85% of participants reported that as a result of this project, communication with patients regarding developmental screening has become easier or much easier.
      • 100% of participants reported that they now discuss both positive and negative screening results with families, an increase of 12% from the pre-implementation survey
      • 96% of participants now self-report that they document the discussion of both positive and negative screening results in the medical record, an increase of 21% from the pre-implementation survey.
      • 43% of participants note that their practice now provides ongoing training and orientation to staff on h​ow to conduct developmental surveillance and screening, an increase of 18% from the pre-implementation survey.​

    Lessons Learned
    • Provide information about validated screening tools at the beginning of the project, including what tools are validated and why using a validated tool is important. Some pediatricians may be unaware that the tools they are using are not validated or are outdated.
    • Practice-wide implementation can be hard in practices with multiple providers, especially if not all providers are involved in the quality improvement project. Providing resources and examples of best practices related to buy-in can be invaluable for those working to address practice-wide change. Consider implementing the QI project with a multi-disciplinary team, including office staff and other clinicians, to assist with project buy-in.
    • ​​Communication is key! Providing support and engagement to and among project participants via monthly webinars and group emails can help participants address barriers, celebrate successes, and share relevant insight and resources.
    Acknowledgement of Support, Contact Information for Additional Support

    This project was supported by a cooperative agreement funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the site content authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the United States Department of Health and Human Services. For more information about the CDC developmental resources and materials, visit Learn the Signs. Act Early.

    For more information about the developmental screening and surveillance toolkits, contact Krysta Gerndt​, Program Manager, Division of Children with Special Needs.​

    Visit the AAP Quality Improvement (QI) website for more information about Quality Improvement at the AAP, including how to participate in QI initiatives. You can also visit the AAP Website for additional information about its Maintenance of Certification Portfolio Program.

    Additional Resources

    Learn the Signs. Act Early.

    The Centers for Disease Control and Prevention (CDC) Learn the Signs. Act Early.​ program aims to improve early identification of children with autism and other developmental disabilities so children and families can get the services and support they need as early as possible.

    Screening Technical Assistance & Resource (STAR) Center

    The Screening in Practices Initiative envisions a system of care in which every child receives the ​screening, referral, and follow-up needed to foster healthy development. The overall goal of the Screening in Practices Initiative is to improve the health, wellness, and development of children through practice and system-based interventions to increase rates of early childhood screening, referral, and follow-up for developmental milestones, maternal depression, and  social determinants of health. The Screening Technical Assistance and Resource (STAR) Center offers free assistance to pediatric health care providers seeking to improve early childhood screening, referral, and follow-up in their practice or health care system.​